Publications by authors named "Sergio Iavicoli"

161 Publications

Contribution of ICOH to Address the Different OSH Needs among Countries: Results of a Survey.

Int J Environ Res Public Health 2021 04 27;18(9). Epub 2021 Apr 27.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.

The aim of this study is to map the coverage of occupational safety and health (OSH) rules and provisions and their enforcement at a country level worldwide. Members' participation in the International Commission on Occupational Health (ICOH) activities was also investigated. We used a questionnaire-based survey to collect data. An online questionnaire was administered from February 14 to March 18, 2018 to all ICOH members for the triennium 2015 to 2017 ( = 1929). We received 384 completed questionnaires from 79 countries, with a 20% response rate. To synthesize information about the coverage of OSH rules and provisions and their level of enforcement, a synthetic coverage index was calculated and combined with country, gross domestic product (GDP) per capita and the human development index (HDI). We used multiple correspondence analysis (MCA) to analyze the members' participation in ICOH activities. More than 90.0% of the sample declared that in their own country there is a set of rules and provisions regulating OSH in the workplace, and training procedures and tools to improve workers' awareness. However, these rules and training procedures are mainly "partially" enforced and utilized (39.0% and 45.4%). There was no statistically significant association between country and GDP per capita and the synthetic coverage index, whilst controlling for HDI. The level of engagement in ICOH activities is higher in senior members (aged 65 years or older), coming from high-income countries, having held a position within ICOH, with a higher level of education and a researcher position. An integrated and multidisciplinary approach, which includes research, education and training, is needed to address OSH issues and their impact both at global and country level.
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http://dx.doi.org/10.3390/ijerph18094665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125532PMC
April 2021

Occupational Exposure in Industrial Painters: Sensitive and Noninvasive Biomarkers to Evaluate Early Cytotoxicity, Genotoxicity and Oxidative Stress.

Int J Environ Res Public Health 2021 04 27;18(9). Epub 2021 Apr 27.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority-INAIL, Monte Porzio Catone, 00078 Rome, Italy.

This study aimed to identify sensitive and noninvasive biomarkers of early cyto-genotoxic, oxidative and inflammatory effects for exposure to volatile organic compounds (VOCs) in shipyard painters. On 17 (11 spray and 6 roller) painters (previously characterized for VOCs exposure to toluene, xylenes, ethylbenzene, ethyl acetate) and on 18 controls, we performed buccal micronucleus cytome (BMCyt) assay; Fpg-comet assay on lymphocytes; detection of urinary 8-oxoGua (8-oxo-7,8-dihydroguanine), 8-oxodGuo (8-oxo-7,8-dihydro-2'-deoxyguanosine) and 8-oxoGuo (8-oxo-7,8-dihydroguanosine), and cytokines release on serum. We found induction of cyto-genotoxicity by BMCyt assay and inflammatory effects (IL-6 and TNFα) in roller painters exposed to lower VOC concentrations than spray painters. In contrast, in both worker groups, we found direct and oxidative DNA damage by comet assay (with slightly higher oxidative DNA damage in roller) and significant increase of 8-oxoGuo and decrease of 8-oxodGuo and 8-oxoGua in respect to controls. The cyto-genotoxicity observed only on buccal cells of roller painters could be related to the task's specificity and the different used protective equipment. Although limited by the small number of subjects, the study shows the usefulness of all the used biomarkers in the risk assessment of painters workers exposed to complex mixtures.
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http://dx.doi.org/10.3390/ijerph18094645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123868PMC
April 2021

Implementing Smart Working in Public Administration: a follow up study.

Med Lav 2021 Apr 20;112(2):141-152. Epub 2021 Apr 20.

INAIL.

Background: Starting from February 2020, in Italy most organizations have had a forced transition to flexible working practice - called "smart working in emergency" - due to the Covid-19 epidemic outbreak. This allowed to continue work activities and services and contributed to contain the risk of infection in different sectors, particularly in the public administration.

Objectives: This follow up study focussed on a panel of 187 workers from the Italian Workers' Compensation Authority taking part to a pilot project "Smart Working in INAIL" from January 2019 to December 2019. The aim was to investigate the effects of work organization on work attitudes, work-life balance and health outcomes before and after the introduction of the smart working.

Methods: The data were collected at two time points through a web-based questionnaire. The first wave aimed to collect information up to one month before the implementation of the smart working. The second wave aimed to collect information about potential changes occurred after one year of smart working.

Results: This study showed that high demands, low control and low social support might lead to reduced well-being and less satisfaction with work, and have an effect on work engagement and work-life balance. Particularly, improving social support can moderate the negative impact of high strain on well-being, preventing work-life imbalance and risk of isolation.

Discussion: Findings and future perspectives are discussed to support stakeholders in defining policies and practices concerning health and wellbeing at work while preserving productivity, for a successful implementation of smart working in the public administration.
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http://dx.doi.org/10.23749/mdl.v112i2.10595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095324PMC
April 2021

The Role of Occupational Health Services in Psychosocial Risk Management and the Promotion of Mental Health and Well-Being at Work.

Int J Environ Res Public Health 2021 03 31;18(7). Epub 2021 Mar 31.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority INAIL), 00078 Rome, Italy.

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.
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http://dx.doi.org/10.3390/ijerph18073632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036601PMC
March 2021

Risk assessment at work and prevention strategies on COVID-19 in Italy.

PLoS One 2021 19;16(3):e0248874. Epub 2021 Mar 19.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy.

The COVID-19 pandemic has spread worldwide, with considerable public health and socio-economic impacts that are seriously affecting health and safety of workers, as well as their employment stability. Italy was the first of many other western countries to implement extended containment measures. Health workers and others employed in essential sectors have continued their activity, reporting high infection rate with many fatalities. The epidemiological trend highlighted the importance of work as a substantial factor to consider both when implementing strategies aimed at containing the pandemic and shaping the lockdown mitigation strategy required for sustained economic recovery. To support the decision-making process, we have developed a strategy to predict the risk of infection by SARS-CoV-2 in the workplace based on the analysis of the working process and proximity between employees; risk of infection connected to the type of activity; involvement of third parties in the working processes and risk of social aggregation. We applied this approach to outline a risk index for each economic activity sector, with different levels of detail, also considering the impact on mobility of the working population. This method was implemented into the national epidemiological surveillance model in order to estimate the impact of re-activation of specific activities on the reproduction number. It has also been adopted by the national scientific committee set up by the Italian Government for action-oriented policy advice on the COVID-19 emergency in the post lockdown phase. This approach may play a key role for public health if associated with measures for risk mitigation in enterprises through strategies of business process re-engineering. Furthermore, it will make a contribution to reconsidering the organization of work, including also innovation and fostering the integration with the national occupational safety and health (OSH) system.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248874PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978285PMC
April 2021

The impact of vinyl chloride exposure on the health of Italian workers: an evaluation from SIREP compliance data.

Arch Environ Occup Health 2021 Mar 19:1-10. Epub 2021 Mar 19.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.

The aim of the study is to investigate exposures to vinyl chloride monomer (VCM) at workplace in Italy and the related burden of diseases. Measurements data was collected from a nation-wide occupational exposure registry (SIREP, 1996-2016). Potentially exposed workers were estimated for some industrial sectors. Concurrent exposures were investigated using cluster analysis. Proportionate mortality ratios were calculated linking data to national mortality statistics (2005-2015). Overall 8,460 measurements were analyzed. Most exposures occurred in the manufacture of chemicals and plastic products. A total of 12,148 workers potentially exposed was estimated (64% male). Concurrent exposures were detected frequently (83%). An elevated proportion of deaths for liver cancer was found in male exposed workers. Although VCM is a known carcinogen for humans, there are still many exposure situations, albeit at low doses, in the chemical and plastic industries.
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http://dx.doi.org/10.1080/19338244.2021.1900045DOI Listing
March 2021

Biomonitoring of workers employed in a titanium dioxide production plant: Use of buccal micronucleus cytome assay as noninvasive biomarker to evaluate genotoxic and cytotoxic effects.

Environ Mol Mutagen 2021 Apr 22;62(4):242-251. Epub 2021 Mar 22.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority - INAIL, Rome, Italy.

We aimed to evaluate whether TiO production process induces genotoxic and cytotoxic effects on the first target organ of inhalable particles by a sensitive and noninvasive biomarker of effect. Final aim was to find a useful and suitable tool to assess and manage the risk of TiO occupational exposure. We enrolled 40 workers employed in TiO production, 5 office workers, and 18 external controls. Buccal micronucleus cytome assay (BMCyt assay) was applied because it allows to evaluate micronucleus (MN), nuclear buds (NB), and broken eggs (BE) indicating the presence of chromosomal instability and gene amplification and binucleated cells (BIN), karyolytic cells (KL), and condensed chromatin (CC) indicating cytokinesis defect or arrest, cell death and apoptosis respectively. We characterized the exposure measuring inhalable and respirable particles by personal monitoring. BMCyt-assay showed in exposed workers compared with external controls a higher value of MN frequency (2.57 vs. 0.05‰, p < .001) and MN positivity, evaluated as percentage of subjects with MN frequency higher than a 1.5‰ cut-off value (52.5 vs. 0%). We also found in exposed workers higher frequency of BE + NB (2.41 vs. 0.22‰, p = .002), BIN (9.45 vs. 8.44‰, p = .047) and CC (1.80 vs. 0.21, p = .001) than in controls. Moreover, we found a relationship between personal monitoring results and presence of MN and other cellular anomalies. This study demonstrates induction of genotoxic and cytotoxic effects on buccal cells of workers involved in TiO production, suggesting the suitability of BMCyt assay as tool for risk assessment and management of TiO exposure.
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http://dx.doi.org/10.1002/em.22431DOI Listing
April 2021

The effect of occupational exposure to noise on ischaemic heart disease, stroke and hypertension: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury.

Environ Int 2021 Sep 18;154:106387. Epub 2021 Feb 18.

Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy. Electronic address:

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from mechanistic data suggests that occupational exposure to noise may cause cardiovascular disease (CVD). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from CVD that are attributable to occupational exposure to noise, for the development of the WHO/ILO Joint Estimates.

Objectives: We aimed to systematically review and meta-analyse estimates of the effect of any (high) occupational exposure to noise (≥85 dBA), compared with no (low) occupational exposure to noise (<85 dBA), on the prevalence, incidence and mortality of ischaemic heart disease (IHD), stroke, and hypertension.

Data Sources: A protocol was developed and published, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies up to 1 April 2019, including International Trials Register, Ovid MEDLINE, PubMed, Embase, Lilacs, Scopus, Web of Science, and CISDOC. The MEDLINE and Pubmed searches were updated on 31 January 2020. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts.

Study Eligibility And Criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of any occupational exposure to noise on CVD prevalence, incidence or mortality, compared with the theoretical minimum risk exposure level (<85 dBA).

Study Appraisal And Synthesis Methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We prioritized evidence from cohort studies and combined relative risk estimates using random-effect meta-analysis. To assess the robustness of findings, we conducted sensitivity analyses (leave-one-out meta-analysis and used as alternative fixed effects and inverse-variance heterogeneity estimators). At least two review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide tools and approaches adapted to this project.

Results: Seventeen studies (11 cohort studies, six case-control studies) met the inclusion criteria, comprising a total of 534,688 participants (39,947 or 7.47% females) in 11 countries in three WHO regions (the Americas, Europe, and the Western Pacific). The exposure was generally assessed with dosimetry, sound level meter and/or official or company records. The outcome was most commonly assessed using health records. We are very uncertain (low quality of evidence) about the effect of occupational exposure to noise (≥85 dBA), compared with no occupational exposure to noise (<85 dBA), on: having IHD (0 studies); acquiring IHD (relative risk (RR) 1.29, 95% confidence interval (95% CI) 1.15 to 1.43, two studies, 11,758 participants, I 0%); dying from IHD (RR 1.03, 95% CI 0.93-1.14, four studies, 198,926 participants, I 26%); having stroke (0 studies); acquiring stroke (RR 1.11, 95% CI 0.82-1.65, two studies, 170,000 participants, I 0%); dying from stroke (RR 1.02, 95% CI 0.93-1.12, three studies, 195,539 participants, I 0%); having hypertension (0 studies); acquiring hypertension (RR 1.07, 95% CI 0.90-1.28, three studies, four estimates, 147,820 participants, I 52%); and dying from hypertension (0 studies). Data for subgroup analyses were missing. Sensitivity analyses supported the main analyses.

Conclusions: For acquiring IHD, we judged the existing body of evidence from human data to provide "limited evidence of harmfulness"; a positive relationship is observed between exposure and outcome where chance, bias, and confounding cannot be ruled out with reasonable confidence. For all other included outcomes, the bodies of evidence were judged as "inadequate evidence of harmfulness". Producing estimates for the burden of CVD attributable to occupational exposure to noise appears to not be evidence-based at this time.

Protocol Identifier: 10.1016/j.envint.2018.09.040.

Prospero Registration Number: CRD42018092272.
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http://dx.doi.org/10.1016/j.envint.2021.106387DOI Listing
September 2021

[Nanomaterials and occupational health: the INAIL research contribution for responsible innovation and risk prevention for workers in Italy].

G Ital Med Lav Ergon 2020 12;42(4):217-224

INAIL - Dipartimento di Medicina Epidemiologia Igiene del Lavoro e Ambientale (DiMEILA) Centro Ricerche Via Fontana Candida, 1 - 00078 Monte Porzio Catone (Roma).

Summary: In the last years nanotechnologies and nanoproducts are constantly growing up thanks to their promising benefits for social and economic development. Nanomaterials are increasingly used in our daily life, finding application in many sectors such as textile, automotive, electronic, food, etc. In 2012, the European Commission included nanotechnologies among the Key Enabling Technologies (KETs), which provide the basis for innovation in the present century. In parallel to the growing interest at industrial and production level (estimated at about 11 million of tons per year) the number of workers potentially exposed in all nanomaterials life cycle has increased. Concurrently, concerns about the potential effects on human health arose, attracting the attention by the scientific community, in particular on health and safety issues in workplaces. In Italy the industrial market has evolved in the same direction with important economic investments both public and private. Consequently, numerous research groups belonging to the University, Institutions and Research Centers were involved in the study of the main issues to promote a responsible development of nanomaterials. In this framework, the main aim of this study is to highlight the commitment of Italian research in the field of health and safety of engineered nanomaterials, through the initiatives of Italian Workers Compensation Authority (INAIL) for sustainable development of nanotechnologies.
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December 2020

Developing a cost-estimation model for work-related stress: An absence-based estimation using data from two Italian case studies.

Scand J Work Environ Health 2021 May 17;47(4):318-327. Epub 2021 Feb 17.

Department of Management and Marketing, Cork University Business School, University College Cork, Cork T12 K8AF, Ireland.

Objectives: This paper discusses the development of a cost-estimation model for work-related stress based on psychosocial risk exposure and absence from work. It presents findings from its implementation and evaluation in two organizations in Italy, using national-level tools developed by the Italian Workers' Compensation Authority (INAIL). It also provides recommendations for the development of similar cost-calculation methods in other countries.

Methods: The cost-estimation model was based on the human capital approach using an indirect cost indicator: loss of productivity due to days of absence attributable to work-related stress. Furthermore, the population attributable fraction (PAF) epidemiological measure was used to calculate the impact of exposure to work-related stress on the basis of data collected through validated tools developed by INAIL and salary cost data.

Results: The developed model was implemented and evaluated in two organizations, the first in healthcare (N=1014) and the second in public administration (N=534). In the first case, it was found that absence related to work-related stress cost the organization €445 000. In the second case, the cost was €360 000.

Conclusions: The proposed model provides an example of how organizations can incorporate well-established indicators associated with work-related stress (eg, various types of absence, psychosocial risk perception, loss of productivity on the basis of salary costs) in a practical way in cost estimations of work-related stress. Such cost estimation can be applied in other countries and organizations to establish the economic and business case of managing work-related stress.
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http://dx.doi.org/10.5271/sjweh.3948DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091069PMC
May 2021

An integrated and multi-technique approach to characterize airborne graphene flakes in the workplace during production phases.

Nanoscale 2021 Feb 10;13(6):3841-3852. Epub 2021 Feb 10.

Italian Workers' Compensation Authority-Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, I-00078 Rome, Italy.

Graphene is a one-atom-thick sheet of carbon atoms arranged in a honeycomb pattern and its unique and amazing properties make it suitable for a wide range of applications ranging from electronic devices to food packaging. However, the biocompatibility of graphene is dependent on the complex interplay of its several physical and chemical properties. The main aim of the present study is to highlight the importance of integrating different characterization techniques to describe the potential release of airborne graphene flakes in a graphene processing and production research laboratory. Specifically, the production and processing (i.e., drying) of few-layer graphene (FLG) through liquid-phase exfoliation of graphite are analysed by integrated characterization techniques. For this purpose, the exposure measurement strategy was based on the multi-metric tiered approach proposed by the Organization for Economic Cooperation and Development (OECD) via integrating high-frequency real-time measurements and personal sampling. Particle number concentration, average diameter and lung deposition surface area time series acquired in the worker's personal breathing zone (PBZ) were compared simultaneously to background measurements, showing the potential release of FLG. Then, electron microscopy techniques and Raman spectroscopy were applied to characterize particles collected by personal inertial impactors to investigate the morphology, chemical composition and crystal structure of rare airborne graphene flakes. The gathered information provides a valuable basis for improving risk management strategies in research and industrial laboratories.
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http://dx.doi.org/10.1039/d0nr07114eDOI Listing
February 2021

Assessment of the Influence of Crystalline Form on Cyto-Genotoxic and Inflammatory Effects Induced by TiO Nanoparticles on Human Bronchial and Alveolar Cells.

Nanomaterials (Basel) 2021 Jan 19;11(1). Epub 2021 Jan 19.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority-INAIL, 00078 Monte Porzio Catone, Rome, Italy.

Titanium dioxide nanoparticles (TiONPs) are increasingly used in consumer products, industrial and medical applications, raising concerns on their potential toxicity. The available in vitro and in vivo studies on these NPs show controversial results. Crystalline structure is the physicochemical characteristic that seems to influence mainly TiONPs toxicity, so its effect needs to be further studied. We aimed to study whether and how crystalline form influences potential cyto-genotoxic and inflammatory effects induced by two commercial TiONPs (TiO-A, mainly anatase; TiO-B, mainly rutile) in human alveolar A549 and bronchial BEAS-2B cells exposed to 1-40 µg/mL. Cell viability (WST-1), membrane damage (LDH release), IL-6, IL-8 and TNF-α release (ELISA) and direct/oxidative DNA damage (fpg-comet assay) were evaluated. Physicochemical characterization included analysis of crystalline form (TEM and XRD), specific surface area (BET), agglomeration (DLS) and Z-potential (ELS). Our results show that TiO-A NPs induce in BEAS-2B cytotoxicity and a slight inflammation and in A549 slight oxidative effects, whereas TiO-B NPs induce genotoxic/oxidative effects in both cell lines, revealing different toxicity mechanisms for the two tested NPs. In conclusion, our study confirms the influence of crystalline form on cellular response, also demonstrating the suitability of our in vitro model to screen early TiONPs effects.
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http://dx.doi.org/10.3390/nano11010253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835860PMC
January 2021

Retrospective analysis of the Italian exit strategy from COVID-19 lockdown.

Proc Natl Acad Sci U S A 2021 01;118(4)

Center for Health Emergencies, Bruno Kessler Foundation, Trento 38123, Italy;

After the national lockdown imposed on March 11, 2020, the Italian government has gradually resumed the suspended economic and social activities since May 4, while maintaining the closure of schools until September 14. We use a model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission to estimate the health impact of different exit strategies. The strategy adopted in Italy kept the reproduction number R at values close to one until the end of September, with marginal regional differences. Based on the estimated postlockdown transmissibility, reopening of workplaces in selected industrial activities might have had a minor impact on the transmissibility. Reopening educational levels in May up to secondary schools might have influenced SARS-CoV-2 transmissibility only marginally; however, including high schools might have resulted in a marked increase of the disease burden. Earlier reopening would have resulted in disproportionately higher hospitalization incidence. Given community contacts in September, we project a large second wave associated with school reopening in the fall.
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http://dx.doi.org/10.1073/pnas.2019617118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848712PMC
January 2021

Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis".

Scand J Work Environ Health 2021 Jan 7;47(1):87-89. Epub 2020 Jul 7.

Epidemiology Unit, Occupational and Environmental Medicine, Epidemiology and Hygiene Department, INAIL (Italian national workers compensation authority), Via Stefano Gradi 55, 00143 Rome, Italy. E-mail:

Mezei et al's letter (1) is an opportunity to provide more details about our study on pericardial and tunica vaginalis testis (TVT) mesothelioma (2), which is based on the Italian national mesothelioma registry (ReNaM): a surveillance system on mesothelioma, with individual asbestos exposure assessment. Incidence of pericardial mesothelioma has been estimated around 0.5 and 0.2 cases per 10 million person-years in men and women, respectively, and around 1 case for TVT mesothelioma. ReNaM collected 138 cases thanks to its long period of observation (1993-2015) and national coverage. Conducting a population-based case-control study with incidence-density sampling of controls across Italy and over a 23 year time-span should have been planned in 1993 and would have been beyond feasibility and ReNaM scope. We rather exploited two existing series of controls (3). The resulting incomplete time- and spatial matching of cases and controls is a limitation of our study and has been acknowledged in our article. The analysis of case-control studies can nevertheless be accomplished in logistic models accounting for the variables of interest, in both individually and frequency matched studies (4). Furthermore, analyses restricted to (i) regions with enrolled controls, (ii) cases with definite diagnosis, (iii) incidence period 2000-2015, and (iv) subjects born before 1950 have been provided in the manuscript, confirming the strength of the association with asbestos exposure (supplemental material tables S4-7). Following Mezei et al's suggestion, we performed further sensitivity analyses by restriction to regions with controls and fitting conditional regression models using risk-sets made of combinations of age and year of birth categories (5-year classes for both). We confirmed positive associations with occupational exposure to asbestos of pericardial mesothelioma, with odds ratios (OR) (adjusted for region) of 9.16 among women [95% confidence interval (CI) 0.56-150] and 5.63 (95% CI 1.02-31.0) among men; for TVT mesothelioma the OR was 7.70 (95% CI 2.89-20.5). Using risk sets of age categories and introducing year of birth (5-year categories) as a covariate (dummy variables) the OR were similar: OR (adjusted for region) of 9.17 among women (95% CI 0.56-150) and 5.76 (95% CI 1.07-31.0) among men; for TVT the OR was 9.86 (95% CI 3.46-28.1). Possible bias from incomplete geographical overlap between cases and controls has been addressed in the paper (table S4) and above. In spatially restricted analyses, OR were larger than in those including cases from the whole country, indicating that bias was towards the null. Mezei et al further noted that "the regional distribution of controls is different from that of person-time observed". This objection is not relevant because the above analyses were adjusted by region. Our controls were provided by a population-based study on pleural mesothelioma (called MISEM) and a hospital-based study on cholangiocarcinoma (called CARA). In MISEM, the response rate was 48.4%, a low but not unexpected rate as participation among population controls is usually lower and has been declining over time (5). It is important to underline that ReNaM applied the same questionnaire that was used for interviews and carried out the same exposure assessment as both MISEM and CARA. As repeatedly stated in ReNaM papers (6-7), each regional operating center assesses asbestos exposure based on the individual questionnaire, other available information, and knowledge of local industries. Occupational exposure to asbestos is classified as definite, probable or possible. Occupational exposure is (i) definite when the subject`s work was reported or otherwise known to have involved the use of asbestos or asbestos-containing materials (MCA); (ii) probable when subjects worked in factories where asbestos or MCA were used, but their personal exposure could not be documented; and (iii) possible when they were employed in industrial activities known to entail the use of asbestos or MCA. Hence, the definite and probable categories are closer to one another and were combined in our analyses. In any case, restricting analyses to subjects with definite occupational exposure and using each set of controls separately, as suggested by Mezei et al, yielded elevated OR for TVT and pericardial mesothelioma among men using both the above described modelling strategies; the OR could not be calculated for women. There were 70 (25 pericardial and 45 TVT) occupationally exposed mesothelioma cases. In population-based studies, analyses by occupation are limited by the low prevalence of most specific jobs. As briefly reported in our paper, for purely descriptive purposes, the industrial activity of exposure (cases may have multiple exposures), were construction (22 exposures, 7 and 15 for pericardial and TVT mesotheliomas, respectively), steel mills and other metal working industries (4 and 11), textile industries (2 and 3), and agriculture (2 and 5); other sectors had lower exposure frequencies. The absence of industries like asbestos-cement production, shipbuilding and railway carriages production/repair should not be surprising and had already been observed (7). In the Italian multicenter cohort study of asbestos workers (8), given the person-years of observation accrued by workers employed in these industries and gender- and site-specific crude incidence rates, approximately 0.1 case of pericardial and 0.2 of TVT mesothelioma would have been expected from 1970 to 2010. Even increasing ten-fold such figures to account for higher occupational risks among these workers would not change much. Asbestos exposure in agriculture has been repeatedly discussed in ReNaM reports (9: pages 70, 73, 128, 164 and 205). Exposure opportunities included the presence of asbestos in wine production, reuse of hessian bags previously containing asbestos, or construction and maintenance of rural buildings. Similarly, mesothelioma cases and agricultural workers exposed to asbestos have been noted in France (10). In conclusion, the additional analyses we performed according to Mezei et al's suggestions confirm the association between asbestos exposure and pericardial and TVT mesothelioma, supporting the causal role of asbestos for all mesotheliomas. ReNaM`s continuing surveillance system with national coverage is a precious platform for launching analytical studies on pleural and extra pleural mesothelioma. References 1. Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis Scand J Work Environ Health. 2021;47(1):85-86. https://doi.org/10.5271/3909 2. Marinaccio A, Consonni D, Mensi C, Mirabelli D, Migliore E, Magnani C et al.; ReNaM Working Group. Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks. Scand J Work Environ Health. 2020;46(6):609-617. https://doi.org/10.5271/sjweh.3895. 3. Greenland S. Control-initiated case-control studies. Int J Epidemiol 1985 Mar;14(1):130-4. https://doi.org/10.1093/ije/14.1.130. 4. Pearce N. Analysis of matched case-control studies. BMJ 2016 Feb;352:i969. https://doi.org/10.1136/bmj.i969. 5. Bigert C, Gustavsson P, Straif K, Pesch B, Brüning T, Kendzia B et al. Lung cancer risk among cooks when accounting for tobacco smoking: a pooled analysis of case-control studies from Europe, Canada, New Zealand, and China. J Occup Environ Med 2015 Feb;57(2):202-9. https://doi.org/10.1097/JOM.0000000000000337. 6. Marinaccio A, Binazzi A, Marzio DD, Scarselli A, Verardo M, Mirabelli D et al.; ReNaM Working Group. Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register. Int J Cancer 2012 May;130(9):2146-54. https://doi.org/10.1002/ijc.26229. 7. Marinaccio A, Binazzi A, Di Marzio D, Scarselli A, Verardo M, Mirabelli D et al. Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register. Occup Environ Med 2010 Nov;67(11):760-5. https://doi.org/10.1136/oem.2009.051466. 8. Ferrante D, Chellini E, Merler E, Pavone V, Silvestri S, Miligi L et al.; the working group. Italian pool of asbestos workers cohorts: mortality trends of asbestos-related neoplasms after long time since first exposure. Occup Environ Med 2017 Dec;74(12):887-98. https://doi.org/10.1136/oemed-2016-104100. 9. ReNaM VI Report. Available from: https://www.inail.it/cs/internet/docs/alg-pubbl-registro-nazionale-mesoteliomi-6-rapporto.pdf. Italian 10. Marant Micallef C, Shield KD, Vignat J, Baldi I, Charbotel B, Fervers B et al. Cancers in France in 2015 attributable to occupational exposures. Int J Hyg Environ Health 2019 Jan;222(1):22-9. https://doi.org/10.1016/j.ijheh.2018.07.015.
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http://dx.doi.org/10.5271/sjweh.3910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801133PMC
January 2021

Occupational exposure to graphene and silica nanoparticles. Part II: pilot study to identify a panel of sensitive biomarkers of genotoxic, oxidative and inflammatory effects on suitable biological matrices.

Nanotoxicology 2021 03 29;15(2):223-237. Epub 2020 Dec 29.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority-INAIL, Monte Porzio Catone-Rome, Italy.

The available biomonitoring studies on workers producing/handling nanomaterials (NMs) focused on potential effects on respiratory, immune and cardio-vascular system. Aim of this study was to identify a panel of sensitive biomarkers and suitable biological matrices to evaluate particularly genotoxic and oxidative effects induced on workers unintentionally exposed to graphene or silica nanoparticles during the production process. These nanomaterials have been chosen for 'NanoKey' project, integrating the workplace exposure assessment (reported in part I) with the biomonitoring of exposed workers reported in the present work. Simultaneously to workplace exposure characterization, we monitored the workers using: Buccal Micronucleus Cytome (BMCyt) assay, fpg-comet test (lymphocytes), oxidized DNA bases 8-oxoGua, 8-oxoGuo and 8-oxodGuo measurements (urine), analysis of oxidative stress biomarkers in exhaled breath condensate (EBC), FENO measurement and cytokines release detection (serum). Since buccal cells are among the main targets of NM occupational exposure, particular attention was posed to the BMCyt assay that represents a noninvasive assay. This pilot study, performed on 12 workers vs.11 controls, demonstrates that BMCyt and fpg-comet assays are the most sensitive biomarkers of early, still reparable, genotoxic and oxidative effects. The findings suggest that these biomarkers could represent useful tools for the biomonitoring of workers exposed to nanoparticles, but they need to be confirmed on a high number of subjects. However, such biomarkers don't discriminate the effects of NM from those due to other chemicals used in the NM production process. Therefore, they could be suitable for the biomonitoring of workers exposed to complex scenario, including nanoparticles exposure.
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http://dx.doi.org/10.1080/17435390.2020.1850903DOI Listing
March 2021

An innovative approach to identify past exposure to asbestos integrating questionnaire information and administrative data.

Health Policy 2021 Feb 11;125(2):246-253. Epub 2020 Dec 11.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy. Electronic address:

Reconstruction of work history of subjects exposed to occupational carcinogens might be extremely challenging and provide unreliable results. This study, carried out in Italy from February to November 2014, aimed to explore the validity of an innovative approach to reconstruct the occupational history of workers who have previously been exposed to asbestos combining the administration of structured questionnaire with the use of administrative data. Subjects recruited in this study were enrolled in the cohorts of COSMOS 1 and 2 studies. Participants indicating an exposure to asbestos were contacted and a structured questionnaire was administered to them to verify the validity of the self-reported asbestos exposure. Subsequently, work histories of respondents were investigated using administrative information. The record linkage with social security archives allowed the reassembling of the complete work history of 487 participants. In detail, administrative files allow the retrieval of 98 % of workers declaring not to be exposed, versus 77 % using the questionnaire. Furthermore, the percentage of retrieved cases is not relevant for high risk sectors but it is almost double for industries with probable presence of asbestos. The combined and integrated use of structured questionnaire with administrative data proved effective in accurately identifying subjects who actually had an asbestos exposure. This innovative strategy, being cost-effective and easily adaptable to other carcinogens, could be particularly useful in selecting subjects to recruit in specific screening and control programs for the early diagnosis of occupational cancers.
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http://dx.doi.org/10.1016/j.healthpol.2020.11.013DOI Listing
February 2021

Prevalence of work related musculoskeletal disorders in Italian workers: is there an underestimation of the related occupational risk factors?

BMC Musculoskelet Disord 2020 Nov 12;21(1):738. Epub 2020 Nov 12.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Monte Porzio Catone, 00078, Rome, Italy.

Background: Work-related musculoskeletal disorders (WMSDs) represent an important socio-economic burden. The current risk assessment and management involved in the ethiopathogenesis of WMSDs is based on observational tools and checklists, which have some limitations in terms of accuracy and reliability. The aim of this study was to assess WMSD prevalence and identify possible correlations with several socio-demographic and work-related variables in a large cohort representative of Italian workers in order to improve our understanding of the WMSD phenomenon.

Methods: This study includes data from INSuLa, a cross-sectional nationally representative survey of health and safety at work, developed by the Italian Workers' Compensation Authority. A total of 8000 Italian workers were included. Multivariate logistic regression analyses were performed to evaluate the association of independent variables, such as workers' perceptions of exposure to biomechanical/ergonomic and video display unit (VDU) risks (Risk Perceived) and the actual risk exposure (Risk Detected) on Back, Lower and Upper limb pain. Socio-demographic, occupational and other health-related variables were included to investigate possible association with musculoskeletal disorders.

Results: Workers perceiving a significant exposure to biomechanical/ergonomic and VDU risks but not included in a health surveillance program for them (Risk Perceived/No Risk Detected) have had significantly higher odds of reporting musculoskeletal disorders. Regarding the biomechanical/ergonomic risk these workers are in the 19-24 age range (39.9%), transportation, warehousing/information and communication sectors (38.9%) and are employed in companies with more than 250 workers (35.8%). Regarding VDU risk, workers are in the 45-54 age range (24.5%), professional, financial and business services (38.0%) and come from companies with more than 250 employees (25.6%).

Conclusions: Within the occupational safety and health management systems an appropriate assessment of occupational risk factors correlated to musculoskeletal disorders (mainly biomechanical/ergonomic and VDU) and the correct definition of their exposure levels is essential to adequately prevent the onset of WMSDs. In this regard, our findings provide useful information to design novel approaches, aimed at improving our understanding of emerging risks, identifying gaps in current risk assessment strategies and enhancing workplace interventions are mandatory to improve the occupational risk assessment and management process and therefore implement the subsequent health surveillance systems.
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http://dx.doi.org/10.1186/s12891-020-03742-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659235PMC
November 2020

Occupational exposure to graphene and silica nanoparticles. Part I: workplace measurements and samplings.

Nanotoxicology 2020 11 30;14(9):1280-1300. Epub 2020 Oct 30.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Monte Porzio Catone, Rome, Italy.

Few-Layers Graphene (FLG) are able to improve the performance of materials, due to their chemical-physical properties. Engineered amorphous silica nanoparticles (SiONPs) are among the most widespread nanomaterials (NMs) in the world. Such nanomaterials are two case studies of the research project 'NanoKey' that integrated the exposure assessment through personal measurements and sampling in the workplace, as described in the present work (part I), with the biomonitoring of exposed workers (reported in part II). Measurement campaigns were conducted according to OECD and WHO harmonized approach in two production sites. The set of instruments included real-time devices for high-resolution measurements at the nanoscale and time-integrated samplers for the off-line gravimetric analysis and chemical and morphological (SEM-EDS) characterization of exposure in order to identify the contribution of production compared to the background. Values of particle number concentration (PNC) and lung deposited surface area (LDSA) within the FLG production resulted higher than the background far field (FF), even if they are always similar to the near field (NF) ones: the average diameter (D) during the production was higher than the NF background but always lower than the FF values. SEM-EDS analysis highlighted the presence of structures comparable to those produced. During the SiONPs production, the PBZ values showed PNC and LDSA levels higher than the background, with a decrease in the D probably due to NPs emission. SEM-EDS confirms the presence of rare silica nanoparticles. Since the exposure to airborne NMs cannot be excluded in both production sites, a prevention-through-design approach to mitigate the potential risk for workers has been recommended.
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http://dx.doi.org/10.1080/17435390.2020.1834634DOI Listing
November 2020

The management of psychosocial risks at work: state of the art and future perspectives.

Med Lav 2020 Oct 31;111(5):335-350. Epub 2020 Oct 31.

Inail, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Roma.

Background: Psychosocial risk management represents a current challenge in Occupational Health and Safety (OSH) due to their impacts of such risks on work stress and the rapid changes of the world of work. An effective psychosocial risk management can be carried out on the basis of an integrated multidisciplinary model founded on the risk management paradigm. Over years, the occupational medicine has played an important role at national level in this area, contributing to the creation of an integrated and participatory approach.

Objectives: This study explores the developmental process of psychosocial risk management over time in Europe and Italy, to offer an update on the state of the art at a national level and insights on future perspectives.

Methods: Through a reflection on research developments, in Europe and in Italy, we outline how the knowledge obtained has been translated into policies, which have encouraged the implementation at international and national level of consolidated practices for the management of psychosocial risks.

Results: An overview of some key steps of the inclusion of psychosocial aspects in OSH is presented, highlighting the positive impact of the multidisciplinary approach. Moreover, the driving role played by policies for implementation in organizational practice is also highlighted, with particular reference to the Italian example.

Discussion: Starting from the existing knowledge, it is necessary to tackle emerging risks by continuing to translate the knowledge obtained from research into policies that have a driving role in the identification and implementation of actions and practical tools.
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http://dx.doi.org/10.23749/mdl.v111i5.10679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809977PMC
October 2020

The Sensor-Based Biomechanical Risk Assessment at the Base of the Need for Revising of Standards for Human Ergonomics.

Sensors (Basel) 2020 Oct 10;20(20). Epub 2020 Oct 10.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy.

Due to the epochal changes introduced by "Industry 4.0", it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human-robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative "direct instrumental evaluations" and "rating of standard methods", allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers' awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.
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http://dx.doi.org/10.3390/s20205750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599507PMC
October 2020

Work a key determinant in COVID-19 risk.

Lancet Glob Health 2020 11 25;8(11):e1368. Epub 2020 Sep 25.

Italian National Institute for Insurance against Accidents at Work, Rome 00143, Italy.

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http://dx.doi.org/10.1016/S2214-109X(20)30411-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518834PMC
November 2020

Occupational factors in the COVID-19 pandemic in Italy: compensation claims applications support establishing an occupational surveillance system.

Occup Environ Med 2020 12 23;77(12):818-821. Epub 2020 Sep 23.

Department of Medicine, Epidemiology, Workplace and Environmental Hygiene, INAIL, Roma, Lazio, Italy.

Introduction: The SARS-CoV-2 pandemic is an impacting challenge for occupational health. Epidemiological surveillance of COVID-19 includes systematic tracking and reporting of the total cases and deaths, but suitable experiences of surveillance systems for identifying the occupational risk factors involved in the COVID-19 pandemic are still missing, despite the interest for occupational safety and health.

Methods: A methodological approach has been implemented in Italy to estimate the occupational risk of infection, classifying each economic sector as at low, medium-low, medium-high and high risk, based on three parameters: exposure probability, proximity index and aggregation factor. Furthermore, during the epidemic emergency, the Italian Workers' Compensation Authority introduced the notation of COVID-19 work-related infection as an occupational injury and collected compensation claims of workers from the entire national territory.

Results: According to compensation claims applications, COVID-19 infection in Italy has been acquired at the workplace in a substantial portion of the total cases (19.4%). The distribution of the economic sectors involved is coherent with the activities classified at risk in the lockdown period. The economic sectors mostly involved were human health and social work activities, but occupational compensation claims also include cases in meat and poultry processing plants workers, store clerks, postal workers, pharmacists and cleaning workers.

Conclusions: There is a need to go towards an occupational surveillance system for COVID-19 cases, including an individual anamnestic analysis of the circumstances in which the infection is acquired, for the prevention of occupational infectious risk, supporting insurance system effectiveness and managing vaccination policies.
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http://dx.doi.org/10.1136/oemed-2020-106844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677459PMC
December 2020

A Human-Relevant 3D In Vitro Platform for an Effective and Rapid Simulation of Workplace Exposure to Nanoparticles: Silica Nanoparticles as Case Study.

Nanomaterials (Basel) 2020 Sep 6;10(9). Epub 2020 Sep 6.

Istituto Italiano di Tecnologia, Nanoregulatory Platform, Drug Discovery and Development Department, 16163 Genova, Italy.

In this contribution, we show the suitability of a 3D airway model, when coupled with a nebulizer system, for simulating workplace exposure to nanoparticles. As a proof of concept, workplace exposure to silica nanoparticles was experimentally measured in an occupational facility where nanoparticles are produced weekly, and compared with the official limit value for bulk silica materials. These values of potential exposure were simulated in a 3D airway model by nebulizing low doses (from 0.90 to 55 µg/cm) of silica nanoparticles over a prolonged period (12 weeks of repeated exposure, 5 days per week). Overall, the results suggest the efficiency of the defense mechanisms of the respiratory system and the clearance of the breathed silica nanoparticles by the mucociliary apparatus in accordance with the recent in vivo data. This in vitro platform shows that the doses tested may correlate with the occupational exposure limit values. Such relationship could provide regulatory-oriented data useful for risk classification of nanomaterials.
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http://dx.doi.org/10.3390/nano10091761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557931PMC
September 2020

Workers' Exposure Assessment during the Production of Graphene Nanoplatelets in R&D Laboratory.

Nanomaterials (Basel) 2020 Aug 3;10(8). Epub 2020 Aug 3.

Italian Workers' Compensation Authority-Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, I-00078 Rome, Italy.

Widespread production and use of engineered nanomaterials in industrial and research settings raise concerns about their health impact in the workplace. In the last years, graphene-based nanomaterials have gained particular interest in many application fields. Among them, graphene nanoplatelets (GNPs) showed superior electrical, optical and thermal properties, low-cost and availability. Few and conflicting results have been reported about toxicity and potential effects on workers' health, during the production and handling of these nanostructures. Due to this lack of knowledge, systematic approaches are needed to assess risks and quantify workers' exposure to GNPs. This work applies a multi-metric approach to assess workers' exposure during the production of GNPs, based on the Organization for Economic Cooperation and Development (OECD) methodology by integrating real-time measurements and personal sampling. In particular, we analyzed the particle number concentration, the average diameter and the lung deposited surface area of airborne nanoparticles during the production process conducted by thermal exfoliation in two different ways, compared to the background. These results have been integrated by electron microscopic and spectroscopic analysis on the filters sampled by personal impactors. The study identifies the process phases potentially at risk for workers and reports quantitative information about the parameters that may influence the exposure in order to propose recommendations for a safer design of GNPs production process.
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http://dx.doi.org/10.3390/nano10081520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466624PMC
August 2020

Occupational asbestos exposure after the ban: a job exposure matrix developed in Italy.

Eur J Public Health 2020 10;30(5):936-941

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority (INAIL), Rome, Italy.

Background: Asbestos is a well-known carcinogen for humans. The aim of this study is to develop a tool to estimate occupational asbestos exposure in Italy after the ban using information collected in a national dataset.

Methods: Data were collected from firm registries of workers exposed to asbestos in the period 1996-2016. Descriptive statistics (arithmetic mean, standard deviation, geometric mean and geometric standard deviation) were calculated for the main exposure-related variables (activity sector, occupational group and exposure period). An estimate of workers potentially exposed to asbestos was also performed.

Results: A total of 19 704 airborne measurements of asbestos exposure was selected from the national database of occupational exposures in the sectors of asbestos abatement. Overall, a geometric mean of 7.93 f l-1 was found, and chrysotile was the asbestos type that had more exposures (41%). A total of 46 422 workers was estimated to be potentially at asbestos exposure risk. Exposure data were summarized by calendar period, activity sector and occupational group.

Conclusions: The construction of a job exposure matrix for different occupation/industry combinations may allow the assessment of occupational exposure to asbestos in several removal and disposal activities, and the estimate of the risks associated with asbestos-related diseases in epidemiological studies.
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http://dx.doi.org/10.1093/eurpub/ckaa118DOI Listing
October 2020

Environmental contamination by naturally occurring asbestos (NOA): Analysis of sentinel animal lung tissue.

Sci Total Environ 2020 Nov 18;745:140990. Epub 2020 Jul 18.

National Institute for Insurance against Accidents at Work (INAIL), Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy. Electronic address:

Ophiolites are known sources of naturally occurring asbestos (NOA). In Calabria (Southern Italy) NOA are mainly concentrated in the ophiolitic sequences cropping in the Mount Reventino area, in the southern part of the Sila massif, and along the Coastal Chain. The most common type of asbestos identified in the rocks of these areas belongs to the tremolite-actinolite series. Another identified asbestiform mineral is fibrous antigorite belonging to the serpentine mineral group with a minor amount of chrysotile. The purpose of the present study is to evaluate the diffusion of natural asbestiform fibers from NOA using sentinel animals. Fifteen lung samples of sheep, goats and wild boars from Mount Reventino area and two from an area free from NOA were collected. The lung samples were subjected to anatomopathological examination and lung fiber burden analysis by electron microscopy. Abundant tremolite and few antigorite fibers were detected in the lung samples coming from the NOA area. No corpuscle of asbestos was observed. No fiber was found in the two lung samples of sheet from the area free from NOA. These concentrations of fibers per gram of dry weight of lung tissue (f/gdw) ranged from 10 to 10 f/gdw. The asbestos fibers detected in the lungs of the examined animals reflect the geological features of the areas where they grazed and lived. The anatomopathological analysis showed that 60% of the examined animals had macroscopic lesions affecting their lungs. The presence of tremolite fibers in the lungs confirms the diffusion of mineral fibers in the environment and the real advantage of using animal populations in the study areas.
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http://dx.doi.org/10.1016/j.scitotenv.2020.140990DOI Listing
November 2020

Efficacy of sodium hypochlorite in the degradation antineoplastic drugs by NMR spectroscopy.

G Ital Med Lav Ergon 2020 06;42(2):109-120

University of Rome La Sapienza - Department of Chemistry (S. Cannizzaro Building), Piazzale Aldo Moro 5, 00185 Rome, Italy.

Summary: Antineoplastic drugs are used to treat cancer, having their therapeutic effect by inhibiting the cell division process. Although cancer cells, due to their rapid growth, are more sensitive to the toxic effects of chemotherapeutic agents, healthy cells and tissues may also be damaged. Many studies show acute and chronic toxicity both in patients treated with chemotherapy and in exposed workers. In fact, exposure to these substances can also be linked to the formation of different types of secondary tumors. The International Agency on Research on Cancer (IARC) included some antineplastic drugs in Group 1 (carcinogenic to humans), in Group 2A (probable carcinogens for In recent years, many studies have evidenced the presence of antineoplastic drug contamination on work surfaces, materials and floors and based on these observations, international and national guidelines have been published to limit occupational exposure, with particular attention to procedures post-preparation of chemotherapy to limit as much as possible the accumulation of contaminated residues. The aim of the following study is to determine the effectiveness of the degradation of four antineoplastic drugs: 5-fluorouracil, azacitidine, cytarabine and irinotecan using a low concentration of sodium hypochlorite solution (0.115%). The analytical platform used to monitor the degradation course of the substances under examination was hydrogen nuclear magnetic spectroscopy (1H NMR). In the same experimental conditions the effectiveness of the degradation of the same antineoplastic drugs with a 99.9% ethanol solution was also evaluated. The study showed that the best degradation efficiency (> 90% ) is obtained with the hypochlorite solution after 15 minutes.
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June 2020

Predictors of filing claims and receiving compensation in malignant mesothelioma patients.

Health Policy 2020 09 10;124(9):1032-1040. Epub 2020 Jun 10.

Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Via Stefano Gradi, 55, 00143 Rome, Italy.

Although the predominant occupation origin of mesothelioma is well known, determinant factors involved in filing compensation are scarcely investigated. A linkage between incident mesothelioma cases collected by Italian mesothelioma register (ReNaM) and compensation claims and assignment by Italian national insurance Institute (INAIL) has been conducted for cases diagnosed in the period 2010-2015 and occupational exposure to asbestos. Logistic regression models and decision tree models have been used to identify demographic, diagnostic and anamnestic factors significant for filing and receiving compensation. We have included in the analyses 5019 mesothelioma cases, and among them, 3321 (66.2 %) were found in INAIL archives as mesothelioma cases who fil claims for compensation. The modalities of asbestos exposure, sector of working activities and job type are crucial factors. Furthermore, gender, age at diagnosis, area of residence have been found to be significant predictors of probability to fil claims. Relative risks to fil claims were obtained for the above determinants and conditions to maximize the probability to obtain compensation identified. Our findings demonstrate that there is a need to enforce policies for improving awareness of the occupational origin for mesothelioma cases. Stakeholders, occupational health and safety institutions can play an important role for improving the sensitization regarding the rights of compensation benefits, ensuring the equity and the effectiveness of insurance, welfare and public health systems.
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http://dx.doi.org/10.1016/j.healthpol.2020.06.005DOI Listing
September 2020

Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe.

Cancers (Basel) 2020 Jun 24;12(6). Epub 2020 Jun 24.

Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy.

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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http://dx.doi.org/10.3390/cancers12061672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352874PMC
June 2020

Making the Difference in Occupational Health: Three Original and Significant Cases Presented at ICOH Congresses in the 20 Century.

Saf Health Work 2020 Jun 2;11(2):215-221. Epub 2020 Apr 2.

Department of Cultural Heritage, University of Bologna, Ravenna, Italy.

Background: The aim of this study is to illustrate the historical role of the International Commission on Occupational Health (ICOH) congresses as an arena where national and international occupational medicine can dialogue and as the first example of scientific transferability of the research and prevention results that have had such an impact on global public health.

Methods: We used the ICOH Heritage Repository, in which ICOH congress proceedings (from the first congress in Milan in 1906 to the last congress, held in Dublin in 2018), are organised in an orderly way, updated and easily accessible according to open access logic.

Results: We describe studies by three physicians who submitted significant scientific work to ICOH congresses, one on the battle against ancylostomiasis (Volante, 1906), the second (Quarelli, 1928) on carbon disulphide poisoning, and the third (Viola, 1969) on the carcinogenicity of vinyl chloride monomer. Priority is given to Italian cases, on account of the authors' obvious familiarity with the issues.

Conclusion: The visibility offered in ICOH conferences and their published proceedings has boosted the international spread of their findings, contributing to the scientific transferability of the research results and influencing the development of policies and prevention interventions that have had a great impact on global public health.
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http://dx.doi.org/10.1016/j.shaw.2020.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303537PMC
June 2020